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39A-039 (3) BP 022-1133 33 HOCKANUM RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 39A-039-001 CITY OF NORTHAMPTON Permit:Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2022-1133 PERMISSIONIS HEREBY GRANTS I TO: Project# 21022 WWTP RENO Contractor: License: Est. Cost: 1395373 ROBERT WATSON 039833 Const.Class: Exp.Date:04/06/2024 NORTHAMPTON CITY OF SEWERA Use Group: Owner: TREATMENT PLANT Lot Size (sq.ft.)• Zoning: SC/URC/WP Applicant: BAY STATE REGIONAL CONTRACTO'S INC Applicant Address Phone: Insurance: 73 DESERT SANDS LANE (508)776-8441 R2WC382391 YARMOUTHPORT, MA 02675 ISSUED ON:09/12/2022 TO PERFORM THE FOLLOWING WORK: RENOVATING THE EXISTING BUILDING HOCKANUM FLOOD STATION POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: . 59,7 >2 Fees Paid: $ 212 Main Street,Phone(413) 587-1240,Fax:(413)587-1272 Office of the Building Commissioner RECEIVED SEP 1 2 2022 The Commonwealt of assachusetts Office of Public Sa ety tit INSPECTIONS Massachusetts State Building-C.:: o ii i, 1 MA 01060 Building Permit Application for any Building other than a One-or Two-Family Dwelling (This Section For Official Use Only) Building Permit Numhe rr lj 33 Date Applied: Building Official: SECTION 1:LOCATION ti 33 46ckanum Road Ne s• 13e�p1-pn Ott 60 140C.4anuc 1 P16e4 Po•Kp.St-a t:..Qn........ No.and Street City/Town Zip Code Name of Building(if applicable) 31A 03c1 Assessors Map# Block#and/or Lot # SECTION 2:PROPOSED WORK Edition of MA StateCode used If New Construction check here 0 or check all that apply in the two •ows Ixvlo v Existing Building©/ Repair 0 Alteration tl Addition 0 Demolition 0 (Please fill out and submit Append is.2_) 1 Change of Use 0 Change of Occupancy 0 Other 0 Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes No ❑ Is an Independent Structural Engineering Peer Review required"? Yes 0 No 0 Brief Description of ProposedWork"Tirc, tube, Gens:z+c oT 4tmo(:Con oc ex:gt:..phe C1et.4r:aal Secv:te.f der;ptsn=,,n4 t 4.4ptae tarklesI a.t&: ne,u, etett k:tat Sere:e.e. w,nkaf Oa"Jrreel i.L ,It n:t!-ar �e%Mt.P ,eey:c4. 11t1:4i 9t:' ,( Pump ��c` Make, fD3Lf. r.- ar C.h O( pp;.>f�. SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) 0 Existing Use Group(s): /V ur;..c ial Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)& Area Per Floor(sq.ft.) ( ,13% 1 •? t3d Total Area(sq.ft.)and Total Height(ft.) t � 13% l .2+13 g SECTIONS:USE GROUP(Check as applicable) A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business 0 E: Educational 0 F: Factory F-1 0 F2 0 H: High Hazard H-1 0 H-2 0 H-3 0 H-4 0 H-5 0 I: Institutional 1-1 ❑ 1-2 D 1-3❑ 1-4❑ M: Mercantile 0 IZ;,Residential R-10 R-2❑ R-3 0 R-4 0 S: Storage S-1 0 S-2 0 U: Utility 0 Special Use and please describe below: Special Use Description:S }ta'Skt0C.4MrL SECTION 6:CONSTRUCTION TYPE(Check as apylicable) IA 0 1B0 IIA ❑ LIB ILIA ❑ uIB IV CI VA 0 VB 0 SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item) Water Supp y: Flood Zone Information: Sewage Disposal: / Trench Permit: Debr.s Removal: Public Check if outside Flood Zone D Indicate municipal® A trench +'l not be Licensed Disposal Site 0 required GI or trench or specify:l".amrkGrc:al Private 0 or indentif'Zone: or on site system 0 permit is enclosed 0 .5p asp l Railroad right-of-9 Hazards to Air Navigation: MA 1 liclorlc Commia i n Review Prom's: Not Applicable l Is Structure within airport ap roach area? Is their review completed? or Consent to Build enclosed 0 Yes 0 or No 1r Yes 0 No n SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: q t4+ Use Group(s): 3$ Type of Construction: Mason Does the building contain an Sprinkler System?: /Jo Special Stipulations: Design Occupant Load per Floor and Assembly space: A00 r.,te City of Northampton ,° 'v. Massachusetts Ce },k DEPARTMENT OF BUILDING INSPECTIONS ,,,' ` ..;;T.:,- ,, 212 Main Street • Municipal Building '�y a E- -` Northampton, MA 01060 ssl y�.•-•3„��',,� PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR COMMERCIAL & MULTI-FAMILY NEW CONSTRUCTION/ADDITIONS/ALTERATIONS /1. Building Permit Application signed by legal owner and filled out by owner or authorized agent. /2. One set of plans and specifications of proposed work (Digital & Hard copy). 3-. Cite-t'tatt-wrtHe • nd sctboek-s-r th--Co4str i i ts-lay appliEa t-. /5. Worker's Compensation Insurance Affidavit filled out and signed by applicant. /6. Contractors must supply a copy of CSL and proof of Liability Insurance. 7. ificate (if applisablc)-. d-(if- #icablc). pplicab4e). /12. Initial Construction Control Documents filled out and signed by the Registered Design Professional in responsible charge. -NeFthatttprter SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner C:4.1r Qc Noemnao gi•on la.S t_ec,ost, ch•rte,A. Not44•Uonet-oA 0104,0 Name(Print) No.and Street City/Town Zip Property Owner Contact information: C14-7 & ..,gt LI13 -Sr- t370 - _d_CcleiarZn6r-441aMp ao rvkA go✓ Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: Bay State,P:or,al C.o•,l-rec.tor, 7n Dece.o,Sa,,,ds t—ar,e. s{Qr.•aou sport MA 00.67S ' Name int,, Street Address City/Town State Zip to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1) If a building is less than 35,000 cu.ft.of enclosed space andjor not under Construction Control then check here❑. Otherwise provide construction font re!forms(see section 107 in the code)as required. 10.1 Registered Professional Responsible for Construction Control (the professional coordinating document submittals) 1 1 Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expire,tion Date ! ( 10.2 General Contractor Bay Sta44. (:0++2t Con rrsGtors,TY,L. -- Company Name geb YJ;iso r. CC-03s833 Name of Person Responsible for Construction License No. and Type if Applicable '73 Dozer Sa.,ds 1--2•10 Y2rmo.714+por MA 04.6 75 Street Address City/Town State Zip 5015 -'? - Telephone No.(business) Telephone No.(cell) e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(AI.G.L c.152.§ 25C(6)) A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the ' suance of the building permit. Is a signed Affidavit submitted with this application? Yes it No 0 SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ t$345,,3?3.00 1.Building $ t f Qar,$C1 6D.Gt7 Building Permit Fee=Total Construction Cost x 4(Insert here 2.Electrical $ 3 64 J S t 3.a0 appropriate municipal factor)=$ Aii/A . 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ N/A (contact municipality) 5.Mechanical (Other) $ Enclose check payable to Nti.. 6.Total Cost $ ii ZIS,373.oc (contact municipality)and write c leck number here k A SECTION 13:S IC;NATURE OF BUILDING PERMIT APPLICANT By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate� to the best of my knowledge and understanding. _Bo6 t&}akon �o'Cre 4,j ,-- NOS;de.m 5og -rm. - ecty I .o'(o7laa Please print and sign name Title •Telephone Nppc� Date 73 Desoct- Sands Lane 1.are,outkpoct A4A 0Zb75 _bahmatso4t4ibsrc .con, Street Address City/Town State Zip Email Address i Municipal Inspector to fill out this section upon application approval: *_ ' If ' & ` 4 /0):). i Name t ll Ri e The Commonwealth of Massachusetts il... ..w P jliff:t+ Department of Industrial Accidents r :MN 4. .1= , "I A. , ......,49 1 Congress Street,Suite 1(10 Boston,MA 02114-2017 •c06, www.in ass.govidia Workers'Compensation Insurance Affidavit:13uilderh,0 I El t ra ct ors/Electricians/Plumbers. TO BE FILED WITH-niE Pt/01111 I.\(.;AUTHORITY. Applicant Information Please Print Letiblv Name clausinesVOrganantionfludividual): 6 ay 4.e... ReAr.. ai c. , ,x,c, Address: City/StatefZip: ‘(arrelocitl., r i- Mli. oa 7s Phone#: sot - 776-t ci Li 1 An}Yin an empty)er°Check the appropriate NA: Type of project(required): i.gi I am a employer with citipluyeca KIWI andlor partgruno,• 7. 0 New construction rj, a.a sole proprietor or partnaship arid Law nu employ:let waiting for me in 8. gfRemodeling any catsicity,[No workers'comp,insurance required.) 9. 0 Demolition 3EJ i am a homouwrict doinE all wiut myself_[No wurk*as'comp.irutrance required.] 10 0 Building addition 4.0 I am a hurnixoamo and will be hiring twin/mare.to conduct all work on my propixty. 1 will ensure that all muumuus either have wortem*compensatunt inautance ut me sole I I.0 Electrical repairs or additions pruptienus with no cmployont. 110 Plumbing repairs or additions 510 I am a genera/contructur load I have hired the sub-canutours listed tau the attached sheer. i 3.EIRoof repairs Thou:sui,ccattrackm:have tanpluyees and have workers'comp.insurance. 14.El6.E3 We are a ourpocation and i6 lltikVIN ilitVe ex arised(hair right of exemption per MG!.c. Other 152,f 1(4),and we haws nu unployues.[Nu workers'comp.insurance require-ill •Any applicant that checks butt PI moo ciao till nut Inc scent=below hbuwing their workers conipenwinti pniie2, information- 'Horstoawners who autsinit this affidavit illitie3hap they an.doing all work and than hire untside contractors mail 511bIrat it new afra6vit indicating such. ;Contractun,that acck this box liana at t--c bed an additional sheet shmcinr the name of the suls-contr.Lctors and state whether or nut thiac entities lute employees. lithe anb-coniracturt,hat inni,loyo:s,Lilo mu,.:priAide then worl,cru'nimp policy itumb..n. I ant an employer that is providing worAers'compensation insurance for my employees. Below is the policy and job.site information. Insurance Company Name: A WIG,ba gel Lsavvz. Co. Policy itt or Self-ins.Lie.4.% Rav\lC.StiSZ3ctl Expiration Date: 01-1/Z.A" 0a/Oti,2 3 Job Site Address:.;3 Roc.Varuf er4 Rood CitylStateiZip: ls3neks., ...virkov,) Ntik oto60 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration dun:). Failure to secure coverage as required under MGL c. 152,*25A is a criminal violation punishable by a fine up to 51,500.00 andiur one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$2.50.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 I do hereby certyy under the pains end penalties of perjuly that rite information provided above is true and correct. Si ena lure: /39).(.. a..49/..4.4"ca Date: 0e1/07/..7.2 Phone#: 507s'-776 44) Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License if Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.ChytTown Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone ti: �"S �r A GRD CERTIFICATE OF LIABILITY INSURANCE DATE(MMmonvyY) 02/15;2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be I endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statlment on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Jackie Mantes NAME: Cross Insurance {arc,No.EMI, 812-2600 �AfX hot, (603)570-1073 75 Portsmouth Blvd. E-MAIL PortCerts©crossagency.com I ADDRESS: Suite 100 INSURER(S)AFFORDING COVERAGE I NAIC C Portsmouth NH 03801 INSURER A: Crum&Forster Specialty Ins C 4 44520 INSURED INSURER B: Central Mutual Bay State Regional Contractors,Inc INSURER C: Crum&Forster Ins Co 73 Desert Sands Lane INSURER D: AmGuard Ins Co j 42390 INSURER E: Yarmouthport MA 02675 INSURER F: COVERAGES CERTIFICATE NUMBER: 22-23 All lines REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TIMts CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER POLICY EFF POLICY EXP LW TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMlDDIYYYY) IMMIODIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY t 1,000,000 EACH OCCURRENCE S DAMAGETO RENTED 50,000 CLAIMS-MADE X OCCUR PREMISES{Ea occurrence) $ MED EXP;Any one person) 5 5.000 A EPK-138622 02/01/2022 02/01/2023 PERSONAL a ADV INJURY s 1,000.000 GEN'LAGGREGATE.LIMITAPPUES PER. GENERAL AGGREGATE S 3,000,000 X POUCY C�c ri LOC PRODUCTS•COMPIOP AGG $ 3,000,000 5 OTHER. AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 5 1,000,000 .Ea acddentl ANY AUTO BODILY INJURY(Per aerson) 5 20,000 B — ovvrio X SCHEDULED BAP 8945011 02/01/2022 02/01/2023 BODILY INJURY(Per accident) $ 40,000 AUTOS ONLY AUTOS HIRED N., NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY AUTOS ONLY (Per accident: $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE S 5,000.000 C —^ EXCESS UAB GLAIMS•MADE EFX-119750 02/01/2022 02/01/2023 AGGREGATE $ 5,000,000 DEO RETENTION$ S WORKERS COMPENSATION X STATUTE. OTH- ER _ AND EMPLOYERS'LIABILITY y{N 1,000.000 O ANY PROPRIETOR/PARTNER/EXECUTIVE ('r,j N/A R2WC382391(3a.)MA 02/0812022 02/0812023 E L.EACH ACCIDENT S • OFFICER/MEMBER EXCLUDED? F. 1,000,000 (Mandatory{n NH) E L.DISEASE-EA Et.1PLOYEE 5 If yes,describe under 1 000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 5 , Each pollution condition 1,000,000 Contractors Pollution A 02/01/2022 02/01/2023 Deductible 5,000 DESCRIPTION OF OPERATIONS)LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more space is required) Project Project Hockanum Flood Control Pump Station Phase 1 Upgrades.City of Northampton,MA&Tighe&Bond,Inc.are included as additional insured on a primary&non-contributory basis with respects to the CGL,business auto&umbrella policies as required by executed written contract with the above named insured.GL additional insured includes on-going&completed operations Refer to attached policy forms. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Tighe&Bond,Inc. ACCORDANCE WITH THE POLICY PROVISIONS. 53 Southampton Road AUTHORIZED REPRESENTATIVE Suite 3 �/'',,(QJ+i � Westfield MA 01085 �J���t�tizze o'+ rL�� , " I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ACOR DATE(MMIDOIYYYY) CERTIFICATE OF LIABILITY INSURANCE 03102/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Jackie Monies NAME: Cross Insurance PHONE (603)812-2600 FAX (603)570-1073 NVC,No.Est); NM,No): 75 Portsmouth Blvd. E-MAIL portcerts Clcrossag ency'GOm ADDRESS: Suite 100 INSURER(S)AFFORDING COVERAGE NAIL e Portsmouth NH 03801 iNSURERA: Evanston Insurance Company 35378 INSURED INSURER B: City of Northampton INSURER C 125 Locust Street INSURER 0: INSURER E Northampton MA 01060 INSURER F COVERAGES CERTIFICATE NUMBER: 22-23 OCP Northampton REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDLSUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LW IN50 WVO (MMlDDIYYYY) (MM100IYYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE TO S CLAIMS-MADE C OCCUR PREMISES lEa occurrence) 5 MED EXP{Any one person) $ PERSONAL&ADV INJURY $ GENII.AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE POLICY L.jteT C LOC PRODUCTS-COMPIOPAGO 5 OTHER: AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ - OWNED -SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ _ AUTOS ONLY ^ AUTOS ONLY (Per accident; $ UMBRELLA UAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION S S WORKERS COMPENSATION PER OTH• AND EMPLOYERS'UABILITY Y 1 N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE f- E.L.EACH ACCIDENT OFFICER/MEMBER EMBER EXCLUDED? ( N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,descobe under 0ESCRIP-iON OF OPERATIONS below EL.DISEASE-POLICY LIMIT S Each Occurrence 5,000,000 General Liability-Owners/Contractors A Protective 3FC6545 03/14/2022 03/14/2023 General Aggregate 5,000.000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Tighe 8 Bond Inc. ACCORDANCE WITH THE POLICY PROVISIONS. 53 Southampton Rd Suite 3 AUTHORIZED REPRESENTATIVE / /'off Westfield MA 01085 j��%) Ilea ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts kg.) Division of Occupational Licensure Board of Building Re ulations and Standards Const 9r osor CS-039833 pires 04/06/2024 ROBERT wSON' �j,': 73 DESERT SANDSALO , '" x»4� s 4 YARMOUTH tpRT > • ',0 Commissioner ( )rL a Appendix 1 Construction Documents are required for structures that must comply with 780 CMR 107. The checklist below is a compilation of the documents that may be required. The applicant shall fill out the checklist and provide the contact information of the registered professionals responsible for the documents. This appendix is to be submitted with the building permit application. Checklist for Construction Documents* Mark"x"where applicable No. Item Submitted Incomplete Not htequired 1 Architectural ✓, 2 Foundation f 3 Structural / 4 Fire Suppression 5 Fire Alarm (may require repeaters) i` 6 HVAC 1 7 Electrical I S Plumbing(include local connections) ✓ 9 Gas(Natural,Propane,Medical or other) / 10 Surveyed Site PIan(Utilities,Wetland,etc.) 11 Specifications / 12 Structural Peer Review ✓` 13 Structural Tests&Inspections Program ✓ 14 Fire Protection Narrative Report /, 15 Existing Building Survey/Investigation ✓ 16 Energy Conservation Report 17 Architectural Access Review(521 CMR) / iS Workers Compensation Insurance J 19 Hazardous Material Mitigation Documentation ✓ 20 Other(Specify) Me.c,11an:eyai I f 21 Other(Specify) ✓� 22 Other(Specify) 'Areas of Design or Construction for which plans are not complete at the time of application submittal must he identified herein.Work so identified must not be commenced until this application has been amended and the proposed construction document amendment has been approved by the authority having jurisdiction. Registered Professional Contact Information Joh.t Fr�wtt 4t.-S?d -_.5..a ict_........ sciaoray : t,G60.+d.w., 4t41'1 Name(Registrant) Telephone No. e-mail address Registration Number 53 Sovvhumocn 1ZA. ___Wt s cic.IA MA biois5 ` ruche.t o6/3o/a't Streett► Address 54•c.'3 City/Town State Zip DisciplineG1 Expiration Date t"a;'�l taj [1pA+�y+O yid" ! t)t: t+ti rHMvno-D4- , 4tb1 _ Name(Registrant) Telephone No. e-mail address ttln Registration Number 53 SotAt apt►pe'a.. Rd. _ 1rAtcu,l1 . Ma *hoes Ela c:c i oq.$0! 'L.. Street Address Sit.-3 City/Town State Zip Discipline Expiration Date Zaas Cin')rn.ya1/4, _. till -4'1d.- 3W7el ?.p 010tfl att 1�":ghb�'le^d 4gs131 Name(Registrant) Telephone No. e-mail address , (,15," Registration Number 5% 5ov4 •�a.np+-a.', RA • We.54-1t-ti:l� MA Qto j Act obl3oAt Street Address SAT„'5 City/Town State Zip Discipline Expiration Date Please follow this link for construction control forms to be used by Registered Design Professionals. Initial Construction Control Document pki. To be submitted with the building permit application by a 'g' lak S ' Registered Design Professional. ~„ for work per the ninth edition of the '- Massachusetts State Building Code, 780 CMR, Section 107 Project Title: gate 9`9'2022 Hockanum Flood Pumping Station Phase 1 Upgrades Project Property Address: Project Check(x)one or both as applicable: New construction Fxisting Constru on X The work consists of demolition of existing electrical service, equipment, undergr and fuel storage Project description: tanks, and installing new electrical service, motor control center, wiring, above gr and fuel storage tanks, sanitary sewer service with grinder pump, and rooftop fall protection ancho point. Work John includes site restoration. I Frawley MA Registration Number: 41817 Expiration date: ,am a registered design professi ntal and I have prepared or directly supervised the preparation of all design plans,computations and specifieati concerning1: Architectural (Structural) Mechanical I Fire Protection Electrical Other: for the above named project and that to the best of my knowledge, information, and belief such plans, computations and specifications meet the applicable provisions of the Massachusetts State Buil Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and a that I (or my designee) shall perform the necessary professional services and be present on the construction on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings, s pies and other submittal_by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable_ 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and giiality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions f 780 CMR 107. When required by the building official,I shall submit field/progress reports(see item 3.)togeth with pertinent comments,in a form acceptable to the building official Upon completion of the work,I shall submit to the building official a"Final Construction Control Document" Enter in the space to the right a"wet' or 4`).' OF MqS electronic signature and seal: , FRA.AWL LEY o CIVIL `., No.41817 Phone number: 413-572-3219 Email: JFrawley@tighebond.com Building Official Ilse Only 09/0• " Building Official Name; Permit Na. Date: Nate 1.Indicate with an'x°project design plans,computations and spe ificatsorts that -eaia prepared or directly supervised.i.If'other'is chosen,provide a description_ Version 01 01 2018 Initial Construction Control Document j To be submitted with the building permit application by a t r Registered Design Prof essional �'- b „/ 7 for work per the ninth edition of the Massachusetts State Building Code, :SO CMR,, Section 107 Project Title: Date: 9/9'2022 Hockanum Flood Pumping Station Phase 1 Upgrades Project Property Address: Project: Check(x)one or both as applicable: New construction Existing Construction X The work consists of demolition of existing electrical service. equipment, underground fuel storage Project description: tanks, and installing new electrical service, motor control center, wiring, above ground fuel storage tanks, sanitary sewer service with grinder pump, and rooftop fall protection anchor point. Work Matthew includes site restoration. I Romano mA Registration Number: 48169 Expiration date:6/30/24 ,am a registered design professional,and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerningl: Architectural Structural Mechanical Fire Protection (lectrical) Other: for the above named project and that to the best of n w knowledge, information, and belief such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I (or my designee) shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1 1- Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2- Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable_ 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official,I shall submit field/progress reports(see item 3.)together with pertinent comments,in a form acceptable to the building official Upon completion of the work,I shall submit to the building official a 'Final Construction Control Document'. Or MSS Enter in the space to the right a "wet°" or ,4r`' ' 84, c MATTHEW t, electronic signature and seal: zr ROMANO 4, o ELECTRICAL -�'.) No.48169 Phone number: 413-8;5-1306 Ems: MJRomano@tighebond.com 09/0'%." Al, . Building Official Use Only Building Official Name: Permit Na. Date: Note L Indicate with an"..Kr prciect dsien plans,computations and specifications that you prepared or directly, supervised.If`other'is chosen,provide a description_ Version 01 01. 2018 1, "" Initial Construction Control Document 1, \ '\l To be ssubmit eed z pith the building permit application by a ;� Registered Design Professional �l, for work per the ninth edition of the Massachusetts State Building Code, 780 CMR„ Section 107 Project Title: Date: 9/09/2022 Hockanum Flood Pumping Station Phase 1 Upgrades Project Property Address: Project: Check(x)one or both as applicable: New construction F .�cting Constru 'on X The work consists of demolition of existing electrical service, equipment, underg ound fuel storage Project description: tanks, and installing new electrical service, motor control center, wiring, above g ound fuel storage tanks, sanitary sewer service with grinder pump, and rooftop fall protection anch.r point. Work Zach includes site restoration. IchornyakIvIA Registration Number: 49238 Expiration date:6/30;2024 am a registered design pro , •nal. and I have prepared or directly supervised the preparation of all design Marts,computations and specificati. concerning:: Architectural Structural o- cho--- Fire Protection Electrical Other: for the above named project and that to the best of my knowledge, information, and "ef such plans, computations and specifications meet the applicable provisions of the Massachusetts State B - ding Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and a that I (or my designee) shall perform the necessary professional services and be present on the construction on a regular and periodic basis to: 1_ Review, for conformance to this code and the design concept, shop drawings, s pies and other submittals by the contractor in accordance with the requirements of the construction d eats. 2- Perform the duties for registered design professionals in 780 CMR Chapter 1 as app able_ 3_ Be present at intervals appropriate to the stage of construction to become generally - 'ar with the progress and quality of the work and to determine if the work is being performed in a er consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions f 780 CMR 107. When required by the building official,I shall submit field/progress reports(see item .)toga with pertinent comments,in a form acceptable to the building official. Upon completion of the work,I shall submit to the building official a'Final Construction Control Document`. Enter in the space to the right a"wet" or OF A/ ��H AS Digitally signed by electronic signature and seal: �`�� son Zachariah Chornyak * ZACHARIAH yG o Date: 2022.09.09 ? CHORNYAK ret o CIVIL y 09:47:52-04'00' Phone number: 413-572-3279 Email: ZPChornyak@tighebond.com v No.49238 cn A !` . Building Official Use Only ^ESS/0 AIE��'� Building Official Name: Permit No.: Date09/0 Note 1.Indicate with an'x'project design plans,computations and specifications that you prepared or directly supe v red.If'other'is chosen,prozde a description. Version 0101 2018